The change in my life was surreal... aside from the obvious financial changes... I went from business class international travel, a window office and meeting thought leaders in various medical fields..... to driving all over the state, trying to find space for my laptop at the often cramped nurses station, and trying to explain to the elderly demented woman that this was her home now (because shes been driving the nurses and staff bonkers coming every 5 minutes making up stories on how she has to get home to cook dinner for her kids... who she thinks are still 8 years old).
So when I heard about "Being Mortal: Medicine and What Matters in the End" I said.... ahhh I don't need to read this... I live it! Boy was I wrong. One day I was driving my father to one of his doctor appointments and on a complete whim I put the audio version of this book on hold at my local library. One morning I woke up to find the libary pinging my phone telling me that the audio version was now available for download. I wasn't "reading" anything at the time so click..... I downloaded the book and started listening to it on my drive to work.
I quickly realized that even if you know anything about care for the aging this book is one of those eye openers. Gawande goes back through the socioeconomic evolution of how aged people lived in the past. He explains that the problems we face now days in terms of dealing with aging is just natural because our global population has evolved. Gawande's grandfather himself worked till the day he died at the ripe old age of 110. Naturally he goes through the biological changes associated with aging. He points out that we understand aging better now because there are more people reaching old age. He talks about how nursing homes evolved... even more insteresting how assisted living facilities evolved, and all the while sharing examples... back stories, real life examples. Including the story of his aging own father. Despite the fact that his father, mother and he himself are all doctors practicing medicine in the US they still were overwhelmed with what to do in dealing with his fathers condition and with all the research he did for this book there were points where he still did not make the "right" decision for his father. This brought back memories of my own grandfathers passing and how at the time I could not understand how my family was letting him continue to suffer with enteral tubes and the like. This book spoke to my heart.
Who needs to read this book: Anyone with parents over the age of 60 that are still alive. We are part of the "sandwich" generation, who find themselves caring for their own children and trying to meet the needs of aging parents. I think for us its important to have more compassion for the changes going on in our parents lives. I am not sitting here and saying flip your life completely upside down for them.... Gawande shares an example of a woman who did just that for her aging father and showed how royally that can backfire. But really to remember sometimes dignity is more important than safety and to accept the changes that are happening in their lives. (I know that I have not always been accepting of the changes going on in my own parents lives).
I will leave you with some of my favorite quotes from the book.....
“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
"Assisted living is harder than assisted death."
"Technological society has forgotten what scholars call the “dying role” and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms. This role is, observers argue, among lifes most important for both the dieing and those left behind and if it is, the way we deny people this role out of obtuseness and neglect is cause for everlasting shame. Over and over we in medicine inflict deep gauges in peoples lives and then stand oblivious to the harm done."
“Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be. We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?”
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